Nursing Homes and Dental Care for Residents

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It is estimated that there are nearly 2 million elderly Americans living in nursing home facilities, and the vast majority of residents require assistance with “activities of daily living” or ADLs including oral hygiene.

A study conducted in 2006 of five long-term care facilities in upstate New York showed that a mere 16 percent of residents received any sort of oral care, and for those who did receive case, toothbrushing only lasted an average of 16 seconds — far short of the recommended 2 minutes.

The elderly face a range of oral health care risks simply because of what aging means in terms of oral health.

Elderly and Oral Health

Perhaps the main challenge to helping the elderly maintain good oral health is the fact that nearly one-third of nursing home residents experience dry mouth. Dry mouth or xerostomia is usually a result of taking various medications needed to treat dementia, anxiety, allergies, asthma and high blood pressure. Saliva production naturally decreases as a person ages, and the need for these medications makes the situation worse.

Saliva is the body’s main way of fighting buildup of bacteria in the mouth and decreased levels of saliva production leaves residents at risk for overgrowth of the gums, periodontal disease, and tooth decay.

Poor oral health has been connected with increased rates of weight loss, heart disease and nursing-home-acquired pneumonia (NHAP).

What makes the situation even more challenging is that:

• Many seniors lose any dental care coverage when they retire;

• Medicare does not cover routine dental care (eg: cleanings, fillings), and the extent of coverage of dental services in general can vary from state to state;

• There may be a shortage of dental practitioners who visit long-term care facilities;

• Some health care staff are not trained or are overworked and have so many people under their care that oral hygiene falls behind feeding, dressing, washing, and other bodily needs.

• In the case of dementias, patients simply refuse to have anyone touch their mouth. Research is continuing to help caregivers and nurses in this regard.

Choosing the Right Nursing Home

When investigating the nursing home options for a loved one, make sure you ask about how they provide dental care for the residents.

Ask questions like:

• Does this nursing home/facility have dentists on-call?

• Does your nursing staff provided routine, day-to-day basic oral hygiene care (at least once a day)?

• Has the nursing staff been trained to identify any oral care issues?

• How does staff address oral care resistance from residents?

When you visit your loved one, make it a habit to examine his/her mouth to ensure that proper mouth care is being given. Tell-tale signs that your loved one may not be receiving care may be a toothbrush that doesn’t look used or a tube of toothpaste that doesn’t seem to get any smaller, visual signs of buildup of plaque and tartar, and/or indications from your loved one that there is pain or discomfort in their mouth.

Some states have their own rules about providing proper oral care in nursing homes, but there are also federal rules in place. It is important that you know what’s required and that you ensure that proper oral hygiene care is being offered.

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